Provider Demographics
NPI:1609584895
Name:DENIS, INDIRA LAMOTHE
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:LAMOTHE
Last Name:DENIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SW 153RD TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3660
Mailing Address - Country:US
Mailing Address - Phone:678-964-0265
Mailing Address - Fax:
Practice Address - Street 1:4700 SW 153RD TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3660
Practice Address - Country:US
Practice Address - Phone:678-964-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care